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TYPES  OF HERNIA

 

Your baby may be born with a weakness or gap in the muscles at the base of the umbilical cord. This causes the abdominal contents to bulge under the skin, which forms a soft lump. This is an umbilical hernia.

 

Another type of hernia is an inguinal hernia, when part of the bowel protrudes through the groin. Other variations are diaphragmatic hernias, which are life-threatening, and strangulated hernias, which are much rarer.

 

An umbilical hernia occurs when the abdominal organs protrude through the abdominal wall. If it occurs, it is usually present at birth but should not cause the baby any pain or discomfort.

 

Umbilical hernias

 

Umbilical hernias affect one in five babies and are more common in low birth weight or premature babies and those with Down's syndrome. If you suspect that your baby has an umbilical hernia, consult your doctor.

 

• Your baby may have an umbilical hernia if you notice a slight lump under his skin around the navel.  The lump is caused by part of his intestines bulging through the hernia. 
• An umbilical hernia varies in size from that of a pea to a small plum your doctor can determine the size by feeling the lump under your baby’s skin. 
• The hernis may be present at birth or appear a day or so afterwards. 
• The hernia is most visible when your baby cries, strains or coughs as pressure pushes his abnominal contents through the hole. 
• The lump can be pushed back by simply pressing on it gently with your finger. 
• Although an umbilical hernia is rarely dangerous, it can be confused with other, more serious conditions. 
• Sometimes, the lump is a sign of exomphalos, a rare defect causing the intestines to protrude through the umbilical cord. It may leak fluid whereas umbilical hernias do not. Exomphalos requires surgery. 

Treating an umbilical hernia

 

An umbilical hernia does not usually require medical treatment. Instead, the parent needs to keep a watchful eye on the swelling, which should get smaller as the baby grows.

 

• If your baby has an umbilical hernia, check it regularly, especially at bathtime, to make sure it's not growing or hardening and that it goes back in when gently pushed. 
• Don't compress your baby's hernia with a bandage, tape or plasters, as this can increase the risk of an infection and skin irritation. 
• Surgery is rarely necessary in young babies, although some parents request it for cosmetic reasons. Older children may have surgery if an umbilical hernia shows no sign of closing by about three or four years, or if the gap gets larger. 

An umbilical hernia usually disappears without any need for medical attention. Your child's belly button should return to its normal size and appearance by the time he is four or five years old.

 

Inguinal hernias

 

An inguinal hernia. occurs when part of the bowel protrudes into the groin (inguinal ring). This type of hernia affects 3 to 5 per cent of healthy full-term babies, but is more likely to occur in boys. In 10 per cent of cases there is a family history of the condition.

 

In about the seventh month of pregnancy, a baby's testes descend into his scrotum. They pass through his abdominal wall via the 'inguinal canal', which should then close. However, sometimes the canal remains open and part of the baby's intestines escape from his abdominal cavity down into his groin, forming an inguinal hernia.

 

Your baby may have an inguinal hernia if there is a swelling or puffy area in his groin. The buldge may be visible all the time or it may appear only when your baby cries, coughs or has a bowel movement. It should be soft and can be gently pushed back into place.

 

The hernia usually appears in one groin. Occasionally, the hernia is accompanied by a hydrocele, which is an accumulation off fluid around your baby's testicles, or an undescended testicle.

 

Occasionally, an inguinal hernia is noticeable when the baby cries, passes amotion or coughs. The condition is more common in premature babies

 

Repairing inguinal hernias

 

An inguinal hernia is repaired surgically. The hernia is not a direct threat to your baby's health, but there is a risk that it will become twisted (strangulated), when it will need to be corrected immediately. If the hernia is not strangulated, surgery may be delayed until your baby is five months old, when he will be stronger.

 

Surgery: the operation to repair an inguinal hernia is a simple day-case procedure performed under general anaesthetic. Your baby's lower abdomen and scrotal region are washed with antiseptic. Then the surgeon makes a small cut in your baby's groin, pushes his intestines back into place and sews up the opening. The hole in your baby's abdominal muscles usually closes by itself as he grows.

 

Aftercare: once your baby wakes up after surgery, you can resume his feeding routine and you may be able to return home within a few hours. The medical staff will show you how to change the dressings and will recommend you give  your baby suitable painkillers over the next day or two. After a few days, you can give him a bath and he can move around normally. You don't need to return to the hospital to have the stitches removed - they should be self-dissolving. As there is a slight risk of infection after surgery, you need to keep an eye on the cut as it heals.

 

Strangulated hernias

 

A strangulated hernia occurs when part of the intestines becomes trapped. As a result, the hernia can't be pushed back in and becomes red and painful.

A strangulated hernia cuts off the blood supply to the intestines, which may burst. This can lead to gangrene within five to six hours.

 

If your baby has an inguinal hernia and you are waiting for surgery, you need to watch for hernia strangulation. If you see any of the following symptoms, call an ambulance straightaway:

• A hard tender swelling in the groin that won't disappear.
• The hernia is growing or changing colour.
• A swollen testicle or scrotum that won't subside.
• Abdominal pain, nausea and vomiting. 

Check your baby's scar daily to make sure it is healing well. If it appears red, hot or your baby seems in pain, see your  doctor.

 

Diaphragmatic hernias

 

A diaphragmatic hernia may occur if a baby's diaphragm (the muscular wall separating his chest and abdomen) fails to develop normally before birth, leaving a hole. As a result, some of his abdominal organs enter his chest.

 

• In severe cases, this compresses the baby's heart and lungs, stopping them from developing properly. 
• When a baby with a diaphragmatic hernia is born, he will have breathing difficulties and may be blue with a sunken or hollowed abdomen, vomiting and severe colicky pain. 
• A diaphragmatic hernia can be fatal and needs immediate surgery. The procedure is complicated and the survival rate depends on the state of the baby's lungs. 
• Following surgery, the baby may need help with breathing for several days or months before his lungs can work on their own. 

For  More  Information:  Please  consult  your  physician  on  your  next  visit.